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Fixing Chest Wall Deformities: A Minimally Invasive Option

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

(Image source)

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves ...

Pain after surgery

If you are scheduled to have surgery, it is normal to be concerned about pain you may experience after surgery.

The best time to talk about post-surgical pain is actually before your operation. Make sure you:

  • Talk to your surgeon about your experience with different methods of pain control.
  • Bring a current list of all your medicines and any drug allergies with you to your appointment.
  • Be honest about your alcohol and drug use. If you are abusing alcohol or drugs, you may experience withdrawal from these substances making your postoperative recovery difficult. If you are a recovering from alcohol or drug abuse we can design a pain management plan to reduce the chance for relapse.
  • Ask questions about the post-surgical pain: the severity, how long it will last, how it will be treated, what medications will be used, how they work, and their possible side effects.
  • Discuss any concerns you have about taking pain medications.

Surgical pain is common and should be expected after your procedure. Luckily, modern pain medications and anesthesia can minimize surgical pain. While we cannot eliminate all pain, we want to make you as comfortable as possible. Our pain management goals are simple:

Pectus excavatum – it looks like the chest is sinking inward

Have you ever noticed someone whose chest sinks inward in the front, kind of like a funnel? The first time I ever noticed this bony malformation was when I was in high school, and a friend of mine on the soccer team had one. It was called “pectus excavatum,” he told me.

In my thoracic surgery training, I was often called upon to evaluate patients with this chest wall abnormality. As a result, I began to delve deeper into some of the issues that may affect people with this type of defect.

Pectus excavatum is the most common chest wall deformity and results from abnormal development of the sternum and its attachments. Most patients are self conscious about the defect and usually focus on its appearance but because this is usually present for much of a person’s life, symptoms associated with it may not be totally obvious. Individuals affected generally get used to how they feel and try to overcome any limitations to the best of their abilities without even knowing that’s what they are doing. Most patients describe some chest discomfort, shortness of breath when exerting themselves, lack of endurance, or feeling embarrassed in social situations when their shirt is off. It is not uncommon to hear patients say that they have trouble keeping up with their friends during activities, or that they avoid any activities that would require them to take off their shirt in public-such as going to a pool.

Most physicians aren’t even aware that there is an effective treatment for pectus excavatum...

Swedish and Minor & James at the Northwest Women's Show

Come to the Northwest Women’s Show held this Friday, March 2 through Sunday, March 4 and visit the various Swedish and Minor & James booths. Come learn about Weight Loss Services, try your hand on the daVinci robot at the Robotics Surgery Program booth, visit Minor & James and ask skin-care questions or learn about the women’s health services available. Or, take a look inside the Swedish Mobile Mammography van and learn about mammograms and breast care.

(Make sure you take advantage of a $2 off coupon for admission to the show!)

We'll also have the hands-on daVinci robot device so you can test your hand skills on the robot and get an idea of what it would be like to be a robotic surgeon at Swedish - you can also meet our gynecological surgeons and ask any questions you have.

Traditional and New Technology in Treating Vascular Disease

On a daily basis, we see patients who are seeking treatment for hardening of the arteries, typically in the legs or neck (PAD-peripheral arterial disease); weakening of the main artery in the abdomen (AAA-abdominal aortic aneurysm); and varicose veins. In each case, there are traditional ways of being treated (what we call “Open” Vascular Surgery) as well as innovative alternatives (what we call “Endovascular” Surgery).

How do we arrive at our recommendations and how do you decide what’s best for you?

It helps if your Vascular Surgeon performs both types of procedures rather than just one since s/he can draw on personal experience as well as the results of research, to tailor treatment to your specific needs.

You have to consider the trade-offs between short and long term risks and benefits.

  • For AAA and varicose veins, endovascular techniques have virtually replaced traditional treatment given their low risk of complications and excellent outcomes, and both are well supported by the literature.
  • In PAD – from the carotid arteries in the neck to various arteries in the legs – results of newer technologies are a “mixed bag.”

If you are referred to and seen by a Vascular Surgeon, be sure and discuss traditional and endovascular treatment options before you make your final decision.

Diagnosing Peripheral Artery Disease (PAD)

(Ed. note - As it is heart month, we asked Dr. Rocco Ciocca, Chief of Vascular Surgery, to explain a little more about heart attacks and peripheral artery disease.)

In the last blog we defined a condition known as PAD, which is a constellation of problems related to narrowing of the arteries outside the heart.

PAD, If left untreated, can lead to having a stroke, worsening high blood pressure, difficulty walking, non-healing sores on the legs and feet and in extreme cases gangrene necessitating amputation of the involved body part.

I briefly mentioned how it can be diagnosed and would like to describe that in more detail here.

The great news is that doctors do not need order a bunch of painful or expensive tests to diagnosis PAD. The best and most cost-effective test is a thorough history and physical exam. During that, the health care provider will listen to your symptoms and ask questions about your medical history and your risk factors.

The major risk factors for PAD are:

  • smoking
  • diabetes
  • hypertension (high blood pressure)
  • high cholesterol levels

Heart Attack and Peripheral Artery Disease (PAD)

(Ed. note - As it is heart month, we asked Dr. Rocco Ciocca, Chief of Vascular Surgery, to explain a little more about heart attacks and peripheral artery disease.)

Most people are familiar with the phrase “heart attack” and know that it can be a life threatening condition.

The most common case of a “heart attack” or myocardial infarction is the sudden closure or clotting of a vessel or vessels that supply blood and thus oxygen and other nutrients to the heart. The heart is a muscle and without adequate blood flow the muscle dies. The most common case of a heart attack is “hardening of the arteries” or atherosclerotic disease of the arteries. The disease, which is most commonly related to various risk factors such as age, smoking, high blood pressure, high cholesterol and high suger levels in the blood (diabetes), causes abnormal blockages to develop in critical blood vessels in the body limiting flow. The blood vessels of the heart are not the only vessels affected.

In fact, hardening of the arteries is a systemic (total body) process that involves many other blood vessels of the body. When it involves the other peripheral arteries of the body it is know as PAD, peripheral artery disease. The diagnosis, prevention, and treatment of PAD are managed by vascular specialists such as vascular surgeons.

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